MEDICARE: CITYWIDE TRANSPORTATION LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	343900000X	Non-emergency Medical Transport (VAN)	268	VA

General Provider Information

NPI Number	:	1316306095
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CITYWIDE TRANSPORTATION LLC

Provider Business Mailing Address
First Line	:	1851 FORT MAHONE ST
Second Line	:
City	:	PETERSBURG
State	:	VA
Zip	:	23805-2761
Country	:	US
Telephone Number	:	804-732-0659
Fax Number	:	804-732-0684

Provider Business Practice Location Address
First Line	:	1851 FORT MAHONE ST
Second Line	:
City	:	PETERSBURG
State	:	VA
Zip	:	23805-2761
Country	:	US
Telephone Number	:	804-732-0659
Fax Number	:	804-732-0684

Authorized Official
Title or Position	:	MANAGING PARTNER
Name	:	LASHAWNDA GHOLSON
Credential	:
Telephone Number	:	804-732-0659

Provider Enumeration Date	:	02/23/2016
Last Update Date	:	02/23/2016

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Directions to “CITYWIDE TRANSPORTATION LLC ” Practice Location

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